ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 C14.8

Billable / Specific HCC v28: 11

Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx

C14
Block
1
Synonyms
897
LCDs
52
Payer Policies
35
Linked CPTs

About ICD-10-CM C14.8

ICD-10-CM code C14.8 represents Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx. This is a billable/specific code in the Neoplasms chapter (block C14). The 2026 edition of ICD-10-CM C14.8 became effective on October 1, 2025.

Coding Tips for C14.8

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

C14.8 is a CMS-HCC v28 risk-adjustment code (category 11). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under C14.8. Per CMS ICD-10-CM Tabular 2026.

  • Primary malignant neoplasm of two or more contiguous sites of lip, oral cavity and pharynx

Type 1 Excludes

Pure excludes, these codes can never be coded together with C14.8. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • 'book leaf' neoplasm [ventral surface of tongue and floor of mouth] (C06.89)

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 11
ESRD-HCC
Category 11
RxHCC (Part D)
Category 11

Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.

Medicare LCD Coverage for C14.8

Local Coverage Determinations (LCDs) from CMS MACs that list C14.8 as a covered diagnosis.

897 LCDs

Showing top 10 of 897 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92524 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96112 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92521 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97130 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97129 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92597 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 97533 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 96110 →
CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Article ID: 54111, Effective: 2025-10-01 00:00:00, 1064 covered, 0 non-covered
CPT 92522 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing C14.8.

52 policies

3 Cigna

Head and Neck Ultrasound - (0549)
Policy ID: MM_0549
Nucleic Acid Pathogen Testing - (0530)
Policy ID: MM_0530
Transthoracic Echocardiography in Children - (0523)
Policy ID: MM_0523

5 Medicare

Billing and Coding: Paclitaxel (e.g., Taxol�/Abraxane �)
Policy ID: ART-52450
Oral Anticancer Drugs - Policy Article
Policy ID: ART-52479
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
Policy ID: ART-52480
Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
Policy ID: ART-54111
Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
Policy ID: ART-54768

CPT Codes Commonly Billed with C14.8

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

35 linkages
  • 97130 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 92608 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 97129 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 92607 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 96110 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 92524 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 92508 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 92597 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 92521 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD
  • 96105 CMS LCD: Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders CMS LCD

Convert C14.8 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
C14.8 1498 10000
C14.8 1499 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 C14.8, Billing FAQ

Is ICD-10 code C14.8 billable? +

Yes, C14.8 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to C14.8? +

ICD-10 C14.8 includes: Primary malignant neoplasm of two or more contiguous sites of lip, oral cavity and pharynx.

What codes are Type 1 Excludes for C14.8? +

Type 1 Excludes (never code together with C14.8): 'book leaf' neoplasm [ventral surface of tongue and floor of mouth] (C06.89)

Does C14.8 affect Medicare Advantage HCC risk adjustment? +

Yes. C14.8 maps to CMS-HCC v28 category 11. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with C14.8? +

Procedures frequently paired with C14.8 include: 97130, 92608, 97129, 92607, 96110.

What ICD-9 codes does C14.8 map to? +

Per CMS GEMs, C14.8 maps to ICD-9 codes: 1498, 1499. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on June 1, 2026.

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